HomeMy WebLinkAbout221 Jefferson St - Applications/Addition or Alteration - 09/08/2011City of
I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
Z/ "www.fcgov.com/building
ILDIPERMIT APPLICATION
APPLICATION NUMBERr"66 APPLICATION DATE
Job Site Address 'Z2 t - 17-1 Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # c/`� My 13�D' .
Last name LAO�r First Name DO31. Middle
street Address 2Z3 Sr. City FORT COL_Lt-_)S State Co Zip osz
CONTRACTOR INFO: Company Name UAMM-f_25t_AITVj Contractor Phone#k-1D'?al'"1(099
Lie Holder Name City of Fort Collins License # Supervisor Cert #
ICdla/ jtV�S
Mailing Address 2ud S1^1
I . K'4tn &-(�-t city— l �D� l StateZip ; LC
LEGAL INFO: Ara 1/7.oF bTq 4 SE 1/Z of c.oT'tl
Subdivision/PUD Filing # Lot # Block # 13 Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft 4006 Comm'I Sq Ft t4o00 # of Stories 2- Bldg Height 7qf'- # Dwelling Units I
1s' Floor Sq Ft `4 00b 2nd Floor Sq Ft L{ooa 3'd Floor Sq Ft MA Unfiished Bsmt Sq Ft
INC
O
Finished Bsmt Sq Ft # of Bedrooms Lj # of Full Baths Z -/. Baths I Y= Baths 3 # of Fireplaces -X>� \
Air Conditioning: YeeNoR Energy info: ( Circle appropriate choice ) 1. ComCheck ❑ 2. ResCheck w/Air Sealing ❑
3. ResCheck w/Blower Door ❑ 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing ❑ 6. Prescriptive w/ Blower Deco
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes []NoF—1 Temp. Pedestal Yes❑ No ❑
Type of Heat: ❑ Gas1-1 Electric Electric Main Breaker Size (Residential only) F-1150�Am—p or Less 200 Amp 0Other
Value of Construction (including labor, material & profit) $ ! O 10C)o
/? � rC' r q / Q � Q
Description of Work: _'CnA 'To/ Vt r� /6 sb4 S fee ( Slvt I t� 1 <IMOVL -4h 91
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Pin msr Mechanical
Framer
Solar
Roofing
Other
Plumbing
Concrete hiew44:72)h< /ht Fireplace
Other
Other
Applicant: I hereby acknowledge that ave read thi5.japplication and state that the above information is correct and agree to comply with all requirements
contained herein and Cit ort Col' s ordi an an state laws regulating building const ion. /
Applicant Signature Print Name�L&� Phone
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
City Of Planning, Development and Transportation
_F®Ayt Collins PO Box 580
281 N College Ave
Ft Collins, CO 80524
970-221-6760 phone 970-224-6134 fax
Commercial Construction Application Information
Revised 03/30/2009
MINSK
A
•�E fit
F 4
Application
Job Site Address:
New Building
Addition
Building owner: bf)o C-t �VCD `T
Remodel/TF
Peck "V crx e.l
Building owner address: 221 Je>r>r>r es� ST. Filer CvL� �a5� &OS ZLI
Building owner phone #:
Name of Business:
Proposed Use: (i.e. medical, office, bank, retail, etc) jzEStU¢.tr,AcL �C�..�,�FJZLtPO—
Project square footage:
For commercial remodels Et tenant finishes, please answer the following questions:
➢ Is the remodaUtenant finishes for an lease circle answer)
existing tenant r new tenant?
➢ If for a new tenant, is this the first tenant to occupy this space? Yes oC:JNZ
➢ If not the initial tenant for this unit, what was the previous use of this tenant
Space?
➢ Are there any exterior building changes associated with the work? es or No
If yes, please describe: ar_Q b€t-vc 59- ZEst0s-3c gSY rE
d�'� Signature of applicant
Name (please print)
Date
Local daytime phone #